HRSA Administrator Betty Duke welcomed all of her predecessors to a historic forum Nov. 9 to mark the 25th anniversary of the agency all of them once led.

The 300 HRSA employees and invited guests who attended were treated to history lessons, lighthearted reminiscences, analyses of current challenges in public health, and advice on future policy and actions.

In her opening remarks, Duke cited the following as some of HRSA’s major accomplishments during the agency’s first 25 years:

• Completing President Bush’s initiative to create 1,200 new or expanded health center sites, leading to a sharp increase in patients served;
  
  
• Implementing and administering the Ryan White HIV/AIDS program, which helps more than half a million low-income people with AIDS lead healthier, longer lives;

Robert Graham, M.D., 1982-1985

David Sundwall, M.D., 1986-1988

Robert Harmon, M.D., M.P.H., 1990-1993

Ciro Sumaya, M.D., M.P.H.T.M., 1994-1997

Claude Earl Fox, M.D., M.P.H., 1997-2001

Elizabeth Duke, Ph.D.,
2001-present

The former administrators followed Duke to the speakers’ podium in chronological order, with Robert Graham leading off and recalling his term as HRSA’s first administrator as a period of “typewriters and black-and-white photos.”

He remembered the months following the election of Ronald Reagan in 1980 as a period of “substantial challenge” due to pressure exerted by incoming administration officials to close down programs. In the end, the newly created HRSA shut down a health planning program and moved to convert programs into block grants that gave states greater discretion to set policy and spending priorities.

In addition to dealing with the difficulties of merging the Health Services Administration and the Health Resources Administration, Graham said HRSA officials had to wrestle with the problem of significant reductions in staff from both agencies. “No one had done it before,” he said.

Despite HRSA’s relative youth, Graham said “the agency’s longevity is unusual” in the health field. “We were told early on that HRSA was a temporary solution and that the agency would not last more than three or four years, so 25 years is a significant milestone.”

HRSA endured, he said, “because in the fractured health care system that we have in the United States, HRSA meets needs that are not being met.” Graham is currently professor of family medicine at the University of Cincinnati School of Medicine.

David Sundwall followed Graham and compared HRSA’s efforts to “the little Dutch boy with his finger in the dike, and HRSA has so many fingers in the dike of this leaky, unfair, complicated and costly health care system.”

“I hate to say it,” Sundwall continued, “but if there hadn’t been HRSA we’d probably have a more reasonable national health system already. By doing damage control and serving needy people, HRSA’s work has ameliorated the pain we’d otherwise experience.” Sundwall is executive director of the Utah Department of Health and president of the Association of State and Territorial Health Officials.

Robert Harmon recalled the “15 minutes of fame” he enjoyed while at HRSA for doing a interview with Mike Wallace of CBS’ 60 Minutes. “It was a story about loan defaulters and no one else in HHS wanted to do it,” he said. “But I did!”

Wallace and his team came to the administrator’s Parklawn office for the interview, he recalled. “He was like a matinee idol. All the women wanted pictures with him and he signed autographs, too.” Harmon is currently director of the Duval County (Fla.) Health Department.

Ciro Sumaya, now the dean of the School of Public Health at the Texas A&M Health Science Center, praised HRSA as “the premier public health service agency in America,” but urged stepped-up attention to the needs of public health workers.

“Currently we’re behind 1984 figures for the public health workforce,” he said. Sumaya called for large-scale increases in the workforce and in the resources made available to them.

A native Texan, Sumaya said he started the agency’s ongoing border health initiative and noted that today’s large-scale movement of people and material across the U.S. Mexico border has created numerous public health issues. “There has been tremendous population growth along the border, especially on the Mexican side,” he said.

Claude Earl Fox tackled disease prevention issues in his remarks, saying that “we talk a lot about prevention, but we don’t do that much about it.

“For example, there will never be enough dentists for everyone in the United States,” he noted. “So we’ve got to look at prevention there.”

Now a research professor in the Department of Epidemiology and Public Health at the University of Miami, Fox urged HRSA to focus more resources on geriatric care, which he said will explode in the next 10 to 15 years. “Most practitioners have no idea how to do geriatric care,” he said.

Fox also said HRSA may create new opportunities by partnering health centers with store-front clinics that are beginning to open in major retail stores like Wal-Mart. “Those clinics don’t offer full services, so health centers could agree to do follow-up for patients that need more care,” he said.

Duke closed the morning forum by saying that HRSA’s emphasis on improving the quality of care its grantees deliver is “absolutely linked to eliminating health disparities in patient outcomes.”

She said current agency efforts to improve care have built on the work done by her predecessors. By revitalizing the Center for Quality, supporting health disparities collaboratives, and pushing for greater health information technology investments, Duke said, HRSA is creating a solid future for the people who depend on its programs.

“Quality is what we’re about,” Duke continued, “because health care for the poor will not be poor health care.”